Monterey County Environmental Public Health Leadership Institute (MEPHLI)

State: CA Type: Model Practice Year: 2019

Monterey County, located on California's central coast, is home to the one of the nation's largest agricultural producers, amounting to nearly $5 billion in annual crop and livestock gross value. The county is also a tourist destination that attracts nearly 4.5 million visitors annually to its dramatic coastline and marine sanctuary. These and other activities compete within an environmentally sensitive region populated by 435,000 residents who are relatively young (46% of residents are under age 30); 15% of the population lives under the Federal Poverty Level. The Environmental Health Bureau's specialists and team members seek to improve land and water environmental quality through education methods, rather than through punitive methods. The MEPHLI provides our staff with leadership skills and competencies to enlist the cooperation of county residents, thereby making them a part of our network of environmental health practices. Environmental health practices are constantly evolving to address the emerging issues that can threaten the health and safety of our county's residents and environments. The MEPHLI program strengthens the leadership skills of Monterey County's environmental health specialists and support staff with hands-on, project based learning in planning, collaboration, systems thinking, personality and emotional quotient assessments, project management, and analysis for effectiveness and quality improvement. The goal of MEPHLI is to expand upon staff leadership abilities and competencies to better respond to ever-changing environmental health challenges. Objectives include: Provide 100% of environmental health staff in leadership training through MEPHLI, to enhancing individual strategic visioning and direction-setting skills, critical thinking and analysis abilities, political awareness, program effectiveness, and organizational and team relationship development. Create proactive environmental public health leaders at all levels within the organization to facilitate working in tandem, especially in response to unexpected events. Use the core functions of public health (10 Essential Services of Public Health) as a foundation for achieving environmental public health goals. Review performance outcomes and using participant feedback to inform further improvements. Modeled after the Centers for Disease Control (CDC) Environmental Public Health Leadership Institute (EPHLI), Monterey County's Environmental Health Bureau customized the MEPHLI and graduated its first cohort in October 2015. Four cohorts have graduated to date. Each cohort of approximately 10-12 individuals meet about 14 times over the course of one year, and cohort members additionally meet with a personal coach a minimum of six times during the year. Leadership training topics include: Recognizing personality styles and emotional quotients in self and others Creating a Professional Development Plan Identifying the Ten Essential Services of Public Health, the Health Department's primary initiatives, and the value of Public Health Accreditation Understanding the Seven Habits of Highly Effective People Project Management Systems Thinking Logic Modeling and basic program evaluation Conducting SWOT analyses and rapid quality improvement techniques Each cohort member is responsible for completing an individual project that demonstrates their learned skills and relates to one of ten Essential Services of Public Health. Projects are created with the intention that they will evolve over time and do not end with graduation. Project examples include: Bedbug Control for Shelters Implementation of a Food Scraps Collection Program to Increase Monterey County's Land Fill Diversion Enhancing Public/Private Partnerships to Increase Efficiencies and Promote Public Health and Safety Actions to Improve Chemical Facility Safety & Security-Strengthening Community Planning & Preparedness Foodborne Illness Public Education and Prevention Disaster Planning for Animal Services Agricultural Field Toilet Inspection Program Onsite Inspection Program for Mobile Food Facilities Reverse 911 Public Alert System for Ammonia Releases Medical Waste Management Plan To date, more than 75% of staff have attended and graduated from the program, and another cohort will start in January 2019.Importantly, several projects have come to full fruition and have been adopted as standard practice or protocol, including: Mold: Public Outreach and Education Wilderness Public Health and Safety (Leave No Trace) Housing Complaints Guidelines Other projects are in varying stages of development and refinement. Of particular note are the Wilderness Public Health and Safety project, which included the cooperation of the U.S. Forest Service, and the Environmental Health Specialist Training Program for Consumer Health Protection Trainees, which recently assisted with ten EHS Trainees passing their REHS certification. Other than reaching our goals of having 100% of staff graduate from MEPHLI and having positive anecdotal feedback from cohort members on training content and delivery, MEPHLI had no other performance measures per se. The results of a cohort survey regarding the value of and accessibility to MEPHLI coaches were as follows: Did you meet with your coach? 100% Yes” Was it often enough, too often? 88% Yes,” 12% More often would be better.” Was your coach accessible to you? 100% Yes” Did you receive resources from your coach? 100% Yes” What else could your coach have provided? 100% No, coach was supportive, met my needs, helpful” Any tips on what would have benefited you more? Key problem was assigned coach was in another office, too far away. Difficult to get together and telephone meetings don't work well for me. Assign coaches who are at same physical location as the trainees. I would have liked to have more session guidance on the final project including poster and project layout, content and purpose. It would be helpful to clarify that the project could just be proposed - not actually finished within the year time period. That caused a lot of stress. Can't think of any. Other comments or suggestions: My coach was knowledgeable and helpful but meeting with another coach who works at my location was much more useful. I suggest that coaches and trainees work at the same location because short, frequent meetings are more effective than longer, infrequent meetings. Marni was great! There seemed to be a disconnect between the personal training, the professional training and the project. Had a difficult time meshing the 3 goals. Could use more help with the transition from the training and applying to the project. Overall - great experience. Very happy and grateful to be a part of the program. I learned a lot about myself which will be used personally and professionally. 7 habits is amazing. Thank you so much for this wonderful opportunity. The goal and objectives of relating MEPHLI cohort member projects to the 10 Essential Services has been met: of the 10 Essential Public Health Services, examples of our cohort member projects can be specifically applied to these: Monitor Health Status Aligning FDA Standardization with the 10 Essential Services to Facilitate the Reduction in Food Borne Illness Diagnose and Investigate AB 411 Ocean Water Monitoring-Sampling and Posting Inform, Educate, and Empower Developing Informational Advisories that are Both Informative and Understandable by the General Public Mobilize Community Partnerships Building and Enhancing Public/Private Partnerships to Increase Efficiencies and Promote Public Health and Safety Develop Policies & Plans Housing Complaint Guidelines Enforce Laws and Regulations Monterey County EHS Enforcement Field Guide Link People to Needed Services One County One License Assure Competent Workforce The MEPHLI Program Evaluate Effectiveness Coordination of Multi-program Environmental Health Inspections in Remote Areas Research Innovative Solutions Agricultural Field Toilet Inspection Program These specific factors led to the success of MEPHLI: MEPHLI was introduced by our Bureau Director with assistance and support of the Assistant Director, and supported by our County Administrative Officer, who attends each graduation ceremony which helps the Bureau demonstrate the value and importance of MEPHLI to cohort members. The Bureau and MEPHLI was recognized by our County Board of Supervisors for contributing toward our goal to develop a learning organization that will benefit staff, our bureau, and the health department. Staff were extended formal invitations to attend MEPHLI as the program is not mandatory. The MEPHLI coursework is conversation-based vs. lecture-based to stimulate creativity in problem solving. The use of credible, relatable outside instructors lends to the concept that this is an opportunity for staff to learn from the best.” Cohort members were allowed to select and develop projects of their own choice that were applicable to their work center. Personal coaching throughout the MELPHI learning stages provides credibility that MEPHLI is an investment in personal growth, an opportunity to be a change maker, and address problems that cohort members identify with in their daily work environment. Having specific time set aside during the work day to attend classes and develop projects helped participants feel that they were supported by their supervisors and managers. Conducting a formal project presentation, a graduation ceremony, and receiving diplomas from the County Chief Administrative Officer emphasizes that participants' work and commitment to the program is recognized. Websites applicable to MEPHLI are: 1. Monterey county Health Department, Environmental Health Bureau MEPHLI website: 2. Centers for Disease Control and Prevention EPHLI website:
MEPHLI is the customized use of an existing teaching method and learning resources to improve and develop the leadership competency of our workforce, specifically in the realm of strategic visioning and direction-setting through critical thinking and analysis (systems thinking); political effectiveness; organizational and team development; and use core functions of public health as a foundation for achieving environmental public health goals. Graduates are proactive environmental public health leaders at all levels within our organization who can mobilize resources in response to the changing public health environment (core competencies), enhance the performance outcomes of the essential services of environmental public health; and promote and improve the delivery of environmental public health services. MELPHI is a customization of the Centers for Disease Control (CDC) Environmental Public Health Leadership Institute (EPHLI) program. Monterey County Health Department, Environmental Health Director John Ramirez ,and Assistant Director Ric Encarnacion, are EPHLI graduates who both recognized the importance and value of EPHLI training in their development as leaders and wanted to offer this leadership development opportunity to all Bureau staff. The practice is innovative as we took leadership training tools acquired at a now inactive CDC institute, customized and shared them with our local environmental health staff, and gave our participants the opportunity to apply what they had learned to improving local environmental health issues. Innovatively, cohort training and work on their individual project is integrated into the course of standard work periods as a job related task. The Centers for Disease Control (CDC) Environmental Public Health Leadership Institute (EPHLI) program, upon which MEPHLI is derived, is evidence-based.
Our goal is to have each cohort member complete the MEPHLI and the individual Leadership Project that relates to Environmental Public Health essential services. To date, 75% of all Environmental Health staff have graduated from MEPHLI, and a new cohort will start in January 2019. MEPHLI will initiate the 5th cohort in January 2019. Beyond that, we estimate it will take another two cohorts to reach our 100% goal. If budget constraints arise, we may conduct the final two cohorts in 2018-2019 and 2020-2021 rather than annually. This evaluation method supports our goal objective #1. An important component of leadership training is developing the understanding of one's own personal styles and those of others, how to make decisions in collaboration, and improving critical thinking, especially in networked systems where positive impacts to one area can negatively manifest in other, unexpected areas. MEPHLI provides DiSC and emotional quotient assessments; systems thinking skills; and SWOT analysis, problem identification, and solution testing. Upper management have received positive feedback from cohort members regarding all of these measures. This evaluation method supports our goal objective #2. Every cohort participant identified one or more of the ten essential services of Public Health to develop their project and problem resolution. In projects where more than one of service was identified, the participant demonstrated how the services were connected through an environmental health lens. The projects are presented via PowerPoint to the Health Department and Environmental Health management teams, the County CAO and all prior cohort graduates of MEPHLI . Explanatory posters are displayed during the graduation ceremony and after graduation they are posted for a full year on the walls of our main location as an example for future cohort members and in recognition of each cohort members work. All staff members who have undertaken their MEPHLI Leadership Project have completed their goals, although some projects have moved into additional phases of development and adoption. This evaluation method supports our goal objective #3. Our MEPHLI program evaluation consists of a coaching feedback survey, administered through Survey Monkey, to learn from participants their opinions of MEPHLI's coaching component. Less formally, our upper management have discussed the results of each cohort's performance and outcomes with the coaches and instructors for the purpose of fine tuning the delivery of training sessions. This evaluation method supports our goal objective #4. Further, Monterey County Environmental Health Bureau tracks six performance measures that are reported to our Board of Supervisors, and our results are posted where staff see. Our current performance measures are these: Increase the percentage of moderate risk and highest risk food facility inspections each year. Increase the pounds of recyclables/ waste collected by volunteers, and increase the number of volunteers at County-assisted clean-up events by at least 10% per year (baseline year for comparisons is FY 13-14). Increase the percent of registered Underground Storage Tank (UST) facilities that are inspected annually. Process at least 90% of all building permit applications within two weeks of receipt. Process at least 90% of all water well applications within 10 working days of payment. Increase the percent of permitted body art operators that have completed required blood borne pathogens training from a certified program. We attribute our ability to meet or exceed these performance measures to MEPHLI. We further cite our MEPHLI as partial satisfaction of the Public Health Accreditation standard for workforce development. The initial MEPHLI cohort was comprised of managers and team supervisors with the intention of setting the example for subsequent cohorts and build our capacity to support MEPHLI from within. Three subsequent cohorts included a mixture of front line staff, finance, specialists, and clerical staff. No required criteria were used to determine individual cohort participants, however, the cohort members were selected to ensure a diversity in work experience. Although much of the work expected of the MEPHLI cohort member is completed independently, the learning experience greatly depends on group interaction and participation, which is an element we believe prepares the individual for recognizing leadership opportunities and engineering positive outcomes. MEPHLI stakeholders mainly include external instructors from community organizations that demonstrate effective leadership models. External instructors can provide cohort members with a bigger picture” of how their leadership skills impact interactions within and outside of the county organization. External instructors develop the content for their programs and material costs are borne by MEPHLI. External instructors who volunteer their time benefit by keeping their teaching skills current and by including their own staff to participate and learn at no cost. MEPHLI is internally funded by the Bureau's training budget. Program costs include materials and instructor fees, that are kept to a limit by using in-house and volunteer instructors. The average cost per cohort member is $800. Our program has been compared to commercial executive training that are two to five times the cost per individual.
No Environmental Health leadership programs existed within the bureau prior to MEPHLI. MEPHLI allows cohort members to idealize their leadership potential and exercise their new skills on projects of their own choosing. MEPHLI training mirrors executive leadership training that has significantly higher costs and time commitments. By utilizing local resources, volunteer trainers, and in-house trainers coaches, we have established a sustainable leadership program that is flexible, relevant, and engaging. Primary data sources are feedback from cohort members regarding the value and satisfaction of coaching that is provided to each cohort. Anecdotally, cohort member informal comments in appreciation for this training to upper management, which have been overwhelmingly favorable, have provided verification that the Environmental Health Bureau is on the right track with MEPHLI professional development. Our method of evaluation has been described above. as for our target population, over 75% of staff have attended and graduated from the program and those job titles include these: Director Assistant Director (2) Accountant I Animal Control Officer Finance Manager I Management Analyst I Management Analyst III (2) Office Assistant II (3 persons) Office Assistant III (2 persons) Principal Office Assistant (2 persons) REHS II (6 persons) REHS III (6 persons) REHS IV (7 persons) REHS Trainee (5 persons) Senior Animal Control Officer Supervising Office Assistant II Our secondary data source was the Centers for Disease Control (CDC) Environmental Public Health Leadership Institute (EPHLI) program, from which we based our core training content before further customizing the content of our MEPHLI program. No consequential modifications were made as a result of the data findings. Overall, cohort members and upper management have found the MEPHLI content to be relevant and directly related to our goals. MEPHLI modifications have been made based on the expertise of our volunteer instructors for example, the 5th cohort will include a session on logic modeling and rapid quality improvement techniques, to be provided by an in-house program evaluation/quality improvement instructor. There is a drive to develop standardized practices and protocols across the board in all Environmental Health services (Consumer Health, Hazardous Materials Management, Solid Waste Management, Recycling Resource and Recovery, Drinking Water Inspection and Testing, and Animal Services), and we are confident that MEPHLI, along with our national public health accreditation achievement supports thoughtful protocol development. Results of the coaching survey described in item #19 above, plus anecdotal feedback provided to supervisors were taken under advisement by the Environmental Health Bureau Director and Assistant Director, who were the hands-on developers of MEPHLI. Modifications, although slight, were informed by these feedback data.
Lessons learned that ensured the success of MEPHLI were: Providing staff with the opportunity to identify a problem of their choosing and propose a resolution to the problem allows for staff to explore and introduce new ideas to old problems. Providing the tools to work through the identification, the analysis, the collaboration of ideas, and respectful inquiry strengthened the participant's growth in their confidence as a leader. MEPHLI sessions allowed staff to identify their own leadership style, their strengths and weaknesses, and their own vision of their contributions to the organization. MEPHLI graduates also have formed a bond with each subsequent cohort as graduate fellows of the program. Lessons learned related to stakeholders that ensured the success of MEPHLI were: Requesting assistance from subject matter experts outside of the organization was overwhelmingly welcomed. As the program has progressed, so has the need, and outside collaborators are more than willing to flex with the needs of the program. Some external collaborators also requested to have their staff sit in on certain teachings. Instead of looking to paid trainers that have little investment in the overall outcome, using local expertise allowed for more opportunities to collaborate with other agencies, both inside and outside of the county structure. Transitioning from use of contracted coach/mentor and instead training mentors from our pool of prior graduates is in line with the CDC concept and has helped to make this an organizational mentoring program. Having two graduates of the CDC's EPHLI program in our Bureau was a significant factor as we developed the cost/benefit outcome. Our ability to bring forward a new and innovative approach to building leadership within the bureau, identify public health problems and propose solutions, and offer our staff a professional development opportunity far outweighed the MEPHLI cost in staff productivity, morale, and workforce retainage. Sending staff to outside training seminars was not a cost effective alternative and would not provide the continuity of keeping the cohort engaged and participatory. The Health Department and EHB, County Administration, and external partners have demonstrated the commitment to grow the program county-wide; stakeholders are committed to achieving this. The Environmental Health Bureau has been recognized by Monterey County Board of Supervisors for its dedication to quality professional development through MEPHLI. We quickly moved from initially paying external trainers to tapping into a core group of in-house experts for training and coaching, thereby keeping our costs to a minimum. Moving into the future, the Environmental Health Bureau's annual budget will continue to have a MEPHLI line item.
Colleague in my LHD